Evidence from a sexual assault survivor is usually collected by a Sexual Assault Nurse Examiner, known as a SANE: a registered nurse with additional forensic training who gathers evidence while also providing medical care. The exam is free under federal law, and you do not need to file a police report to have one.
What a SANE Is
SANEs are registered nurses who have completed forensic education on evidence identification, injury documentation, courtroom testimony, and trauma-informed patient care. The International Association of Forensic Nurses recommends that candidates have at least two years of clinical experience in a field requiring advanced physical assessment, such as emergency or critical care, before entering SANE training. Training combines classroom instruction with supervised clinical hours.1International Association of Forensic Nurses. About SANE
Two board certifications exist: SANE-A for adult and adolescent patients, and SANE-P for pediatric patients. The anatomy, developmental considerations, and communication approaches differ between those populations, which is why the credentials are separate.1International Association of Forensic Nurses. About SANE
The value of a SANE is the combination. One provider handles the medical assessment, the evidence collection, and the documentation that may later be used in court, all in a single visit.
If No SANE Is on Staff
Not every hospital has a SANE available. Rural areas and smaller facilities are especially likely to lack one, and the International Association of Forensic Nurses acknowledges that some patients are turned away as a result.2International Association of Forensic Nurses. No SANE In Sight
When no SANE is on duty, emergency physicians, nurse practitioners, or physician assistants with evidence-collection training can perform the exam. The results tend to be stronger when a trained forensic examiner does the work, but a prompt exam from a less specialized provider is almost always better than no exam at all. If you arrive at a facility without a SANE, ask whether anyone on staff has forensic training or whether they can direct you to a facility that does.
Preserving Evidence Before You Go
Try not to shower, bathe, brush your teeth, eat, drink, or use the bathroom before the exam if you can avoid it. Keep the clothing you were wearing. If you change, put the originals in a paper bag rather than plastic, which traps moisture and degrades biological evidence.
None of this is a prerequisite. People shower, change, and go about their day before deciding to seek an exam, and providers understand that. Evidence may still be recoverable even after those things happen. Imperfect preservation is not a reason to skip the exam.
How Long Evidence Can Be Collected
Earlier is better, but recommended collection windows vary by the type of contact:
- Vaginal contact: up to 120 hours (5 days)
- Bitemarks or saliva on skin: up to 96 hours (4 days)
- Anal contact: up to 72 hours (3 days)
- Oral contact: up to 24 hours (1 day)
These windows come from DOJ-funded research on DNA recovery and represent the outer limits at which collection is considered worthwhile, not a guarantee that usable evidence will be found.3Sexual Assault Kit Initiative. Considerations for Optimal Timeframes for DNA Forensic Evidence Clothing, fingernail scrapings, and other non-body evidence can remain useful well past these windows. When you are not sure if too much time has passed, go anyway and let the examiner decide what is still worth collecting.
What the Exam Involves
The forensic medical examination follows the Department of Justice’s National Protocol for Sexual Assault Medical Forensic Examinations. Every step requires your informed consent, and you can stop the exam or decline any specific part at any point.
It usually starts with a medical history and a conversation about what happened. The examiner asks about the assault not to investigate but to know where to look for injuries and where DNA is most likely to be found. You may also be asked about recent consensual sexual activity so the lab can separate a known partner’s DNA from an unknown profile.
From there, the examiner conducts a head-to-toe physical assessment that may include examination of the mouth, genitals, anus, and other areas where contact occurred. Evidence collection involves swabbing body surfaces for DNA, collecting loose hairs or fibers, taking nail scrapings or clippings, and drawing blood or collecting urine for toxicology if drug-facilitated assault is suspected. Clothing from the assault is collected when available. Injuries are photographed throughout.4U.S. Department of Justice. A National Protocol for Sexual Assault Medical Forensic Examinations
Medical Care at the Same Visit
The visit is also a medical one. Alongside evidence collection, the examiner or an affiliated provider addresses immediate health concerns.
- Preventive antibiotics are offered to reduce the risk of bacterial infections like gonorrhea and chlamydia. The CDC’s recommended regimen for adult survivors includes ceftriaxone and doxycycline.5Centers for Disease Control and Prevention. Sexual Assault and Abuse and STIs – STI Treatment Guidelines
- HIV post-exposure prophylaxis (PEP) may be started when the risk warrants it. PEP must begin within 72 hours of exposure to be effective, and the course runs 28 days.5Centers for Disease Control and Prevention. Sexual Assault and Abuse and STIs – STI Treatment Guidelines
- The first dose of the hepatitis B vaccine is offered when the survivor has not been previously vaccinated and the assailant’s hepatitis status is unknown, with follow-up doses scheduled later.5Centers for Disease Control and Prevention. Sexual Assault and Abuse and STIs – STI Treatment Guidelines
- Emergency contraception is offered when the assault could result in pregnancy.
- Any injuries needing immediate attention are treated before evidence collection begins.
Your Rights
The Exam Is Free
Federal law requires every state, tribal government, and local jurisdiction to provide forensic medical exams at no cost to the survivor. Under 34 U.S.C. ยง 10449, any jurisdiction that fails to cover the full out-of-pocket cost loses eligibility for STOP Violence Against Women Formula Grant funding. The statute defines “full out-of-pocket cost” to include the exam itself, facility fees, copayments, and deductibles, and states cannot require you to seek reimbursement from your insurance.6Office of the Law Revision Counsel. 34 USC 10449 – Rape Exam Payments
If a facility tries to bill you for the forensic portion of the exam, that is a compliance problem on their end. Separate medical treatment that goes beyond the forensic exam, such as setting a broken bone, may be billed through insurance or victim compensation programs depending on your state.
No Police Report Required
You do not have to report the assault to police or cooperate with law enforcement to receive a free forensic exam. The same federal statute prohibits states from conditioning exam access on participation in the criminal justice system.6Office of the Law Revision Counsel. 34 USC 10449 – Rape Exam Payments Evidence can be collected and stored while you decide whether to report. Storage periods for unreported kits commonly range from 10 to 50 years, depending on the jurisdiction.
A Victim Advocate Can Be Present
A growing number of states give survivors the right to have a victim advocate present during the exam. Advocates offer emotional support, explain what is happening at each stage, and connect survivors to follow-up resources. Some states require hospital staff to notify you of this right; others establish the right without a notification requirement. Even where no specific law exists, many hospitals and sexual assault service providers will arrange for an advocate on request.7Office of Justice Programs. Presence of Victim Advocate During Sexual Assault Exam Summary of State Laws
Where to Go
Most forensic exams happen in hospital emergency departments. Some communities also have sexual assault response centers or dedicated SANE clinics with private rooms and staff trained in trauma-informed care, which tend to offer a calmer environment than a busy ED. An emergency department remains an option when no dedicated facility is nearby.
To find a facility, RAINN’s National Sexual Assault Hotline (1-800-656-4673) can connect you with a local provider. Many communities also have local sexual assault service providers with 24-hour crisis lines who can tell you exactly where to go and whether a SANE will be on duty.
What Happens to the Evidence Afterward
Collected evidence moves through a strict chain-of-custody process so it stays admissible in court. Each item is packaged, tagged, and sealed, and every person who handles it signs for it, creating an unbroken record from the exam room to the forensic laboratory. The National Institute of Justice emphasizes that no question should arise at trial about missing items, mishandling, contamination, or breaks in the chain of custody.8National Institute of Justice. Law 101 – Legal Guide for the Forensic Expert – A Chain of Custody – The Typical Checklist
At the lab, DNA analysis is the centerpiece of most sexual assault cases. Analysts compare DNA from the survivor’s body or clothing against known samples to identify or exclude suspects. When no suspect has been identified, the unknown profile can be uploaded to the Combined DNA Index System (CODIS), the national database maintained by the FBI. Federal law authorizes the FBI to index crime-scene DNA profiles alongside profiles from convicted offenders and others whose DNA was collected under applicable legal authorities.9Office of the Law Revision Counsel. 34 USC 12592 – Index to Facilitate Law Enforcement Exchange of DNA Identification Information A CODIS match can identify an unknown assailant or link separate cases to the same perpetrator, sometimes years later. Toxicology testing may also be performed on blood or urine samples, which can reveal drugs or alcohol used to incapacitate the survivor.10Sexual Assault Kit Initiative. Utilizing CODIS for Evidence Obtained from Sexual Assault Kits
Tracking Your Kit
At least 37 states and Washington, D.C., have established or committed to establishing sexual assault kit tracking systems. These online tools let survivors log in and check where a kit is in the process, from collection through testing to storage, without calling law enforcement or the lab. If a tracking system is available in your state, the examiner or victim advocate should give you login information at the time of the exam. If they do not, ask.